Symptoms vary depending on where the ulcer is and how old the patient is. Many patients, especially older ones, may have no symptoms. When symptoms do occur, they tend to come back again and again.
Stomach (or peptic) ulcers may produce few or no symptoms, or they may cause burning, gnawing pain in the upper middle part of the abdomen that is relieved by eating or taking an antacid. Stomach ulcers often are not consistent. For example, eating sometimes will make the pain worse rather than better with certain types of ulcers, such as pyloric channel ulcers, which are often associated with bloating, nausea and vomiting, symptoms of a blockage caused by swelling (edema) and scarring.
Duodenal ulcers tend to cause consistent pain. A patient may feel no pain when he or she awakens, but by midmorning it is present. The pain can be relieved by eating, but it usually returns two to three hours later. Pain that wakes a patient at night is common for duodenal ulcers.
Causes and Risk Factors
At one time ulcers were believed to be the result of too much stomach acid. It is now known that the main factors that lead to ulcers are the bacteria H. pylori and non-steroidal anti-inflammatory drugs (NSAIDS). These disturb the normal defense and repair processes of the mucosal linings, making them more vulnerable to attack from stomach acid.
How H. pylori causes ulcers is not entirely clear. One theory is that the organism causes ammonia to be created so that it can survive in the stomach's acid. The ammonia may then erode the mucous barrier that protects the cells of the digestive tract. Other poisons and enzymes from the bacteria may also be a cause, and proteins produced by the body in response to inflammation may play a role.
NSAIDs tend to cause inflammation of the GI tract lining. Weak acids themselves, NSAIDS cause a number of changes within the stomach, including reduced flow of blood to the stomach, less mucus production, and less cell repair and reproduction. All of these tend to break down the process of defense and repair that keeps the mucosa healthy.